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General NPI Number Information
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NPI Number | 1922490895
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Entity Type | Organization
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Legal Business Name | TRAILS PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 7676 JACKSON DR STE 4
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City | SAN DIEGO
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State | CA
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Zip | 92119-1515
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Country | US
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Telephone | 858-692-5835
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Fax | 619-825-7500
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Provider Business Mailing Address
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Address Line | 6717 MURRAY PARK DR
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City | SAN DIEGO
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State | CA
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Zip | 92120-3911
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Country | US
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Telephone | 858-692-5835
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Fax | 619-825-7500
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Authorized Official
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Title or Position | OWNER/ PHYSICAL THERAPIST
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Name | MR. DARREN SHAUN WILLIAMS
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Credential | P.T.
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Telephone | 858-692-5835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT20328
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License Number State | CA
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